Paying Care Home Fees
Applebys - Helping you gain NHS care home funding
Making arrangements for long term care can be a complicated and confusing experience. If you or they receive correspondence inviting them to a NHS Continuing Healthcare funding meeting you will no doubt be confused about what this meeting is about. This assessment is about the degree of care and nursing support that the NHS should be funding and what proportion the individual should be funding themselves. Most people who are referred to full time residential care will have this meeting arranged by the local authority. At the meeting a representative from the local authority social services (usually a social worker), a nursing specialist from the NHS and a representative from the nursing home will jointly assess the nursing and care requirements of your relative. If there is a degree of ill health which requires nursing care, then it is likely that this element of the charges of the nursing home will be paid by the NHS, the higher this percentage, the lower the contribution from the individual.
Clearly all of the parties present (excepting the nursing home) have vested interests in the degree of contribution by the NHS. The implication for the individual is that if the percentage of care contribution is very low from the NHS then it may mean that the individual has to sell all of their assets in order to pay for their own care.
All too often a home is sold to pay for care however, if they had been aware of and had appropriately applied for NHS Continuing Care then they may have been eligible for a lower percentage of contribution and could have avoided the loss of their home.
Applebys Solicitors are specialists in providing advice and support for all aspects of paying for care home or nursing fees. This includes compiling reports and attending assessments, making appeals against judgements, claiming refunds where payment has been made and shouldn’t have been, and even how to plan for and protect against future care home funding.
What is NHS Continuing Healthcare Funding?
NHS Continuing Healthcare Funding can be provided in both your own home or in a care home and is funded by the NHS for those who have been assessed as having a “primary heath need”. For those who qualify this should meet the full cost of their care. To see if you are eligible for funding you will undergo an Initial Screening. If it appears that you may be able to get free NHS Continuing Healthcare Funding then you will have an Assessment. It is important to note that your eligibility for NHS continuing healthcare provision will be reviewed on a regular basis as your care needs may change.
In addition, it is the case that where support is provided by Local Authorities, and not the NHS, then this may incur a financial charge depending on your income and savings.
Who is Entitled to NHS Continuing Healthcare Funding?
• Long-term or complex medical conditions
• Terminal illnesses or rapidly deteriorating health
• Mobility problems
• Those with cognitive or behavioural issues
• Those with mental disabilities
In addition, with regards to making a claim it is not always clear that payment can be made to:
• Well off people. Who may assume that they would not be eligible (as care fees are not means tested!)
• Those who didn’t know that NHS Healthcare Funding was available and therefore have never had an assessment
• Those whose condition has changed or got worse since a previous assessment
What am I entitled to?
NHS Continuing Healthcare Funding is provided in any setting i.e. your home or a care home as long as you are over 18 and your main need is health related. This payment is free and getting it is NOT dependant on your financial situation, as it is not means tested. If you are eligible then the full cost will be met by the NHS. You will be assessed by your local Clinical Commissioning Group who will decide if you are eligible. But all too often the assessment is not carried out correctly or at all!
How Can We Help?
At Applebys we can support you though the whole process, help you get through assessments and argue your case, including:
• Carry out an independent review of your care home needs
• Preparation and reports for the Initial Assessment
• Attendance at the Assessment meeting to support and guide you
• Determine whether an Assessment has been done properly
• Appeal against an assessor’s judgement e.g. was it carried our correctly?
• Where necessary organising preparation and attendance at a Panel Appeal
• If required, assistance with any on-going 12 weekly assessments.
We have a very competitive fixed costs schedule for this work and if you are interested in our service, let us arrange a meeting to discuss the same.
Refunds / Reclaims
The assessment process can be complicated and adversarial. Sometimes an assessment of needs is not done correctly, including an assessment of the ability to pay before an assessment of their needs is done first. Where the wrong decision regarding fees has been made and you have not received payment for care which you should have received, then you can claim a refund.
A claim can also be made for a person who has passed away. Please be aware that time limits apply for all types of claim.
If you believe yourself or a loved one are paying fees which you shouldn’t be paying, then contact Andrew Lane for a free initial discussion. Having assessed your claim we are able to offer a Damages based - No Win No Fee scheme for payment for most of our clients, or alternatively we will provide a quotation for our services.
The local authority has a duty to make sure that care home fees are paid if the person using the services has assets. You are not allowed, for example, to give away a large sum of money to your children just before you go into care, and expect the Local Authority to pay your bills. The Local Authority has the power to look back at transactions and decide if they amount to a “deliberate deprivation” of assets in order to avoid paying for care.
However, you can plan ahead and protect assets. For example, you may own your home jointly with a spouse. Imagine the situation where your husband goes into care, and is paying for his fees. This could be more than £400 per month. You are still in the marital home but, all of a sudden, you pass on. You own your home jointly, so it automatically passes to your husband in the care home, and it is used up paying the fees.
You could have planned for this in your wills. You could divide your house in half, so, on your death, your half goes to your children rather than to your husband in care. This is a legal way of protecting half of the value of the property.
Also, in certain circumstances, it could be appropriate to transfer your home into a trust. This can remove your home from the assessment process completely. Each transfer needs careful consideration and is recommended by us only when the circumstances are right.
There are certain investments which may also be disregarded for care fee assessment purposes, but this requires the specialist advice of a financial advisor. We can put you in touch with a local firm if that is your wish.
Call Andrew Lane now for a free initial chat on 0800 169 13225 to discuss how we may be able to help you.
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